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General NPI Number Information
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NPI Number | 1790568343
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Entity Type | Organization
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Legal Business Name | BHG AESTHETICS
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 210 N WESTMONTE DR STE 2004
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3357
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Country | US
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Telephone | 689-254-4873
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N WESTMONTE DR STE 2004
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3357
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Country | US
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Telephone | 689-254-4873
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MRS. JUDA MCLAREN
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Credential | CPT
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Telephone | 689-254-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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